Tissue Stabilizer and Methods of Use

ABSTRACT

Devices and methods are disclosed for stabilizing tissue within a patient&#39;s body during a surgical operation to provide a relatively motionless surgical field. The devices involve tissue stabilizers which provide superior engagement with a tissue structure to be stabilized, for example the beating heart. The tissue stabilizer may have one or more stabilizer feet which provide for adjustment of the orientation of the features which engage the surface of the tissue structure. In one instance, the orientation may be adjusted to ensure the engaging features will be properly aligned with the surface of the tissue structure before engagement. In addition, once engaged with or connected to the tissue structure the orientation may be adjusted to yield an optimum surgical presentation of a portion of the tissue structure, for instance a coronary artery or the like. The tissue stabilizer may be configured to use friction, negative pressure, or both to engage the surface of the heart.

FIELD OF THE INVENTION

The present invention relates generally to surgical instruments, andmore particularly to methods and apparatus for stabilizing orimmobilizing tissue during surgery. The tissue stabilizers describedherein are particularly useful for stabilizing the beating heart duringcoronary artery bypass graft surgery.

BACKGROUND OF THE INVENTION

Certain surgical procedures require the surgeon to perform delicateoperations on tissues within the body that are moving or otherwiseunstable. The ability to stabilize or immobilize the surgical siteprovides greatly improved surgical accuracy and precision and reducesthe time required to complete a particular procedure. A large andgrowing number of surgeons, for example, are routinely performingsuccessful coronary artery bypass graft (CABG) surgery on the beatingheart by temporarily stabilizing or immobilizing a localized area of thebeating heart. Methods and apparatus for performing a CABG procedure onthe beating heart are described in U.S. Pat. No. 5,894,843 and U.S. Pat.No. 5,727,569 to Benetti et al., the entirety of which is hereinincorporated by reference.

In a typical CABG procedure, a blocked or restricted section of coronaryartery, which normally supplies blood to some portion of the heart, isbypassed using a source vessel or a graft vessel to re-establish bloodflow to the artery downstream of the blockage. This procedure requiresthe surgeon to create a fluid connection, or anastomosis, between thesource or graft vessel and an arteriotomy or incision in the coronaryartery. Forming an anastomosis between two vessels in this manner is aparticularly delicate procedure requiring the precise placement of tinysutures in the tissue surrounding the arteriotomy in the coronary arteryand the source or graft vessel.

The rigors of creating a surgical anastomosis between a coronary arteryand a graft or source vessel demands that the target site for theanastomosis be substantially motionless. To this end, a number ofdevices have been developed which are directed to stabilizing a targetsite on the beating heart for the purpose of completing a cardiacsurgical procedure, such as completing an anastomosis. Representativedevices useful for stabilizing a beating heart are described, forexample, in U.S. Pat. Nos. 5,894,843; 5,727,569; 5,836,311; and5,865,730.

As beating heart procedures have evolved, new challenges have arisen inthe design and engineering of the stabilization devices. The heart istypically accessed by way of a surgical incision such as a sternotomy orthoracotomy. Often one or more of the blocked or restricted coronaryarteries are located a good distance away from the access incisionrequiring the stabilization device to traverse a longer and moretortuous path and engage the surface of the heart at somewhat difficultangular relationships or orientations. Under the most severe conditions,devices which operate to provide a mechanical compression force tostabilize the beating heart encounter difficulty maintaining mechanicaltraction against the surface of the heart. Similarly, devices whichutilize vacuum to engage the heart have a great deal of difficultycreating and maintaining an effective seal against the moving surface ofthe heart.

Even when the beating heart has been effectively stabilized, the targetcoronary artery may be obscured by layers of fat or other tissue and isvery difficult for the surgeon to see. Moreover, the stabilizationdevices may distort the tissue surrounding the coronary artery or thecoronary artery itself such that the arteriotomy is maintained in anunfavorable presentation for completion of the anastomosis. For example,the coronary artery in the area of the arteriotomy may becomeexcessively flattened, compressed or stretched in a manner that impedesthe placement of sutures around the perimeter of the arteriotomy.

In view of the foregoing, it would be desirable to have methods anddevices for stabilizing the beating heart that are capable ofmaintaining atraumatic engagement with the surface of the beating heartover a wider range of conditions and orientations. It would be furtherdesirable to have stabilization methods and devices which provide forfavorable presentation of the coronary artery.

SUMMARY OF THE INVENTION

The present invention will be primarily described for use in stabilizingthe beating heart during a surgical procedure, but the invention is notlimited thereto, and may be used in other surgical procedures.

The present invention is a tissue stabilizer having one or morestabilizer feet that may be adjusted or oriented to provide optimalengagement against the tissue to be stabilized or to provide an optimalpresentation of a portion of the stabilized tissue. The presentinvention may also include a tissue stabilizer having one or moreflexible or compressible seals to ensure a reliable seal against thetarget tissue and may also include a stabilizer foot having at least oneportion which is adjustable relative to the remainder of the stabilizerfoot.

One aspect of the present invention involves a device for stabilizingtissue within a patient's body comprising a base member, a firststabilizer foot extending outwardly from the base member and beingrotatable relative to the base member about a first axis, and a secondstabilizer foot extending outwardly from the base member and beingrotatable relative to the base member about a second axis. Preferably,the first and second stabilizer feet are independently rotatablerelative to the base member. In a preferred embodiment, the first axisand the second axis are substantially parallel.

The first and second stabilizer feet may each have hollow interiorsdefining first and second vacuum chambers each having at least oneopening adapted to engage at least a portion of the tissue. The openingsadapted to engage at least a portion of the tissue to be stabilized mayhave a raised seal around a perimeter thereof. In one variation theraised seal is made of a substantially rigid material. In othervariations the raised seal is made of an elastomeric material or acompressible foam material.

The base member may comprise an interior chamber therein, the interiorchamber of the base member being in fluid communication with the firstand second vacuum chambers. The base member may comprise a front baseportion and a rear base portion, the front base portion being sealinglyaffixed to the rear base portion. The device may also include a posthaving a distal end connected to the base member and a proximal endterminating in a ball-shaped member. A shaft may be provided having asocket at a distal end, the socket being operably engaged with the ball.

Another aspect of the present invention involves a device forstabilizing tissue within a patient's body having a base member and atleast one stabilizer foot extending outwardly from the base member in afirst direction, the stabilizer foot being rotatable relative to thebase member about an axis of rotation which is oriented in substantiallythe same direction as the first direction. Preferably, the axis ofrotation is at an angle of no more than about 25° to the firstdirection, more preferably, the axis of rotation is substantiallyparallel to the first direction.

In a preferred variation, the stabilizer foot has tissue engagingfeatures adapted to engage an external surface of the tissue to bestabilized, the tissue engaging features being disposed at the bottom ofthe stabilizer foot. The tissue engaging features may comprise a vacuumchamber, preferably having a single opening for engaging the tissue tobe stabilized, or may comprise a plurality of vacuum ports. The tissueengaging features may also comprise a textured surface, a perforatedsheet, or a perforated sheet having projections extending outwardlytherefrom. Preferably, the axis of rotation of the stabilizer foot isoffset from the tissue engaging features, more preferably offset fromand parallel to the tissue engaging features.

The stabilizer foot may have a hollow interior defining a vacuum chamberwith a bottom opening adapted to engage at least a portion of thetissue. The stabilizer foot may also have a raised seal disposed arounda perimeter of said opening, preferably around substantially the entireperimeter. The raised seal may be made from a rigid material, anelastomer, or a compressible foam. The vacuum chamber may have an inletpassage in fluid communication with a source of negative pressure.Preferably, the inlet passage is in fluid communication with an interiorchamber within the base member. The base member may include an externalfluid connection to supply negative pressure to the interior chamber ofthe base member.

Another aspect of the present invention involves a device forstabilizing a coronary artery on a patient's heart comprising a basemember and a stabilizer foot for engaging a portion of the patient'sheart. The base member has an interior chamber and at least a firstbore, typically a cylindrical bore, having a first end in fluidcommunication with the interior chamber of the base member and a secondend open to the exterior of the base member. The stabilizer foot has asubstantially cylindrical fitting having a longitudinal axis, at least aportion of the fitting positioned within the bore and being rotatablewithin the bore about the longitudinal axis.

The stabilizer foot may have a hollow interior defining a vacuumchamber, the vacuum chamber having at least one chamber opening adaptedto engage at least a portion of the heart. The fitting may further havea fluid passage having a first end in fluid communication with theinterior chamber of the base member and a second end in fluidcommunication with the vacuum chamber of the stabilizer foot. A raisedseal may be disposed substantially completely around the perimeter ofthe chamber opening. The raised seal may be rigid, compressible orflexible, preferably compressible or flexible. In a preferredembodiment, the raised seal has a durometer with a valve in the range ofbetween about 35 Shore-A to about 100 Shore-A.

The stabilizer foot fitting may comprise a flange and further include anannular seal positioned adjacent the flange. Preferably, the annularseal is positioned between the flange and the base member. The annularseal is preferably an O-ring. The fitting includes at least one flexurehaving a free end and a raised portion extending radially from the freeend. The raised portion preferably engages the first end of the firstcylindrical bore to restrict movement of the fitting relative to thebase member.

The tissue stabilizer may further include a second substantiallycylindrical bore having a first end in fluid communication with theinterior chamber of the base member and a second end open to theexterior of the base member. The tissue stabilizer may have a secondstabilizer foot having a substantially cylindrical fitting having alongitudinal axis, at least a portion of the second stabilizer fittingpositioned within the second bore and being rotatable within the secondbore about the longitudinal axis of the fitting of the second stabilizerfoot.

Another aspect of the present invention involves a stabilizer foot foruse in engaging a portion of tissue within a patient's body whichincludes a first foot portion having at least one vacuum port, a secondfoot portion having at least one vacuum port, and at least one malleablemember connecting the first foot portion to the second foot portion,whereby the orientation of the first foot portion can be adjustedrelative to the second foot portion. Preferably, the first foot portionis a substantially rigid unitary member having at least two vacuumports.

The first foot portion may have a fluid passage in fluid communicationwith each of the vacuum ports associated with the first foot portion andthe second foot portion may have a fluid passage in fluid communicationwith each of the vacuum ports associated with the second foot portion.The malleable member may be a cylindrical tube having a first end, asecond end, and a lumen extending therebetween, the lumen fluidlyconnecting the fluid passage of the first foot portion with the fluidpassage of the second foot portion, preferably, the tube is made ofstainless steel. In another variation, a flexible tube may be providedto connect the fluid passage of the first foot portion to the fluidpassage of the second foot portion. The malleable member is thenpreferably offset from the flexible tube. Preferably, the stabilizerfoot includes two malleable members offset from opposing sides of theflexible tube.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are top plan and top perspective views, respectively, ofa tissue stabilizer constructed according to the principles of thepresent invention.

FIG. 2 is a bottom perspective view of the tissue stabilizer of FIGS. 1Aand 1B.

FIG. 3 is a cross-sectional view taken along line 3-3 as shown in FIG.1A.

FIG. 4 is a cross-sectional view taken along line 4-4 as shown in FIG.1A.

FIG. 5 is a bottom perspective view of an alternate construction of atissue stabilizer according to the principles of the present invention.

FIG. 6 is an exploded perspective view of a tissue stabilizer.

FIG. 7 is an exploded perspective view of an alternate construction of atissue stabilizer.

FIG. 8A is a magnified partial perspective view of a contacting surfaceof a preferred perforated screen for use in a tissue stabilizer.

FIG. 8B is a partial cross-sectional view showing the perforated screenconfiguration of FIG. 8A engaged against a tissue structure.

FIGS. 9A and 9B are partial cross-sectional views of a tissue stabilizerfoot having a perimeter seal.

FIG. 10 is a partial cross-sectional view of a tissue stabilizer foothaving an alternate perimeter seal.

FIG. 11 is a partial cross-section view of a tissue stabilizer foothaving an alternate perimeter seal.

FIG. 12 is a top plan view of a tissue stabilizer having an alternativeperimeter seal.

FIG. 13A is a top perspective view of the stabilizer foot of FIG. 12.

FIG. 13B is a cross-sectional view taken along line 13B-13B as shown inFIG. 13A.

FIG. 14 is a bottom perspective view of an alternate construction of atissue stabilizer according to the principles of the present invention.

FIG. 15 is a cross-sectional view of one of the stabilizer feet of FIG.14.

FIG. 16 is a bottom plan view of an alternate construction of astabilizer foot according to the principles of the present invention.

FIG. 17 is a cross-sectional view taken along line 17-17 as shown inFIG. 16.

FIG. 18 is a bottom plan view of an alternate construction of astabilizer foot.

FIG. 19 is a cross-sectional view taken along line 19-19 as shown inFIG. 18.

FIG. 20 is a bottom plan view of an alternate construction of astabilizer foot.

FIG. 21 is a cross-sectional view taken along line 21-21 as shown inFIG. 20.

FIG. 22 is a partial cross-sectional view of an alternate constructionof a tissue stabilizer according to the principles of the presentinvention.

DETAILED DESCRIPTION

The present invention involves surgical instruments and methods forstabilizing tissue during a surgical operation. The devices describedherein may be used in a wide variety of surgical applications thatrequire a tissue structure to be stabilized or immobilized to provide asubstantially stable and motionless surgical field on which a surgicalprocedure can be performed. By way of example only, the preferredembodiments described in detail below are directed to the stabilizationof a portion of the heart to facilitate a surgical procedure on orwithin the heart, such as a coronary artery bypass graft (CABG)procedure.

Although the devices and methods of the present invention may haveapplication in both conventional stopped-heart and beating heartprocedures, they are preferably used to stabilize the beating heartduring a CABG operation which has been specially developed to facilitatecompletion of an anastomosis, typically between a target coronary arteryand a bypass graft or source artery, without requiring cardiac arrestand cardiopulmonary bypass.

A typical beating heart CABG procedure involves accessing the beatingheart by way of a sternotomy, mini-sternotomy, thoracotomy,mini-thoracotomy, or other suitable access incision, positioning atissue stabilizer on, around or adjacent a coronary artery to stabilizethe coronary artery, creating an arteriotomy in the coronary artery, andanastomosing the bypass graft or source artery to the arteriotomy.Typically, the tissue stabilizer has a heart engaging member at one endfor engaging the surface of the beating heart and is connected at theother end to a stationary object such as a sternal retractor, ribretractor, or other such stationary structure. Exemplar devices andmethods for accessing the beating heart and mounting a stabilizer deviceare disclosed in co-pending U.S. patent application Ser. No. 09/305,810titled “A SURGICAL RETRACTOR APPARATUS FOR OPERATING ON THE HEARTTHROUGH AN INCISION”, the entirety of which is herein incorporated byreference.

The devices of the present invention involve tissue stabilizers whichprovide superior engagement with the surface of the heart. In preferredembodiments of the present invention, the tissue stabilizer may have oneor more stabilizer feet which provide for adjustment of the orientationof the features which contact or engage the surface of the heart. In oneinstance, the orientation may be adjusted to ensure the engagingfeatures will be properly aligned with the surface of the heart. Inaddition, once engaged with or connected to the heart, the orientationmay be adjusted to yield an optimum presentation of the target coronaryartery and, in particular, the location at which the anastomosis will beperformed.

When the tissue stabilizer is configured to facilitate the use ofnegative pressure to engage the surface of the heart, the stabilizerfeet may include one or more compliant or flexible seals to ensure thatthere will be no vacuum leaks between the stabilizer foot and thesurface of the heart. To ensure that the engaging features provided on astabilizer foot will closely approximate the surface of the beatingheart under operating conditions, the stabilizer foot may have one ormore portions which are adjustable relative to each other so that thestabilizer foot may be shaped according to the requirements of aparticular surgical procedure or according to the specific anatomicalfeatures or characteristics of each individual patient.

Referring to the figures wherein like numerals indicate like elements,an exemplar tissue stabilizer is illustrated in FIGS. 1A-4. Tissuestabilizer 100 preferably has stabilizer feet 105 and 110 whichtypically engage the surface of the heart on opposite sides of acoronary artery. Tissue stabilizer 100 is typically positioned such thatthe coronary artery runs lengthwise in the space between stabilizer feet105 and 110.

For beating heart procedures where the target vessel is occluded, tissuestabilizer 100 preferably has a construction that does not occlude orotherwise contact the vessel as stabilizer feet 105 and 110 are placedon opposite sides of the coronary vessel portion to be stabilized. Thus,stabilizer feet 105, 110 are spaced apart at a distance such that acoronary artery can be positioned therebetween. When stabilizer feet 105and 110 are connected to a common base, the base may include a recessedor raised portion to ensure that the vessel is not contacted by thestabilizer. For example, manifold base 120, to which stabilizer feet 105and 110 are attached, preferably has raised portion 126 under which thecoronary vessel may pass without contact when stabilizer feet 105 and110 are engaged to stabilize the heart in the vicinity of the coronaryvessel.

Stabilizer feet 105 and 110 are connected to manifold base 120 whichwill typically have mounting or connecting features for operablyattaching a suitable shaft or other such structure. Preferably manifoldbase 120 has a ball 135 extending therefrom. A shaft (not shown),preferably having a suitably constructed socket, may be provided toengage ball 135. The shaft may be used to position tissue stabilizer 100at the desired location on the heart and may provide the necessarystructure to hold the tissue stabilizer substantially motionless againstthe forces generated by the beating heart. Of course, the shaft or otherappropriate connecting structure may be operably connected to the tissuestabilizer using any suitable connection which allows the desiredmaneuverability of the tissue stabilizer relative to the shaft. Suitablestabilizer shafts and their connections to a tissue stabilizer aredescribed in co-pending U.S. patent application Ser. No. 08/931,158,titled “SURGICAL INSTRUMENTS AND PROCEDURES FOR STABILIZING THE BEATINGHEART DURING CORONARY ARTERY BYPASS GRAFT SURGERY”, and in EPOApplication 97102789.1, the entirety of each are herein incorporated byreference.

Stabilization of the targeted tissue may be achieved by applying alocalized compressive force to the heart through stabilizer feet 105 and110 using an appropriate connecting structure attached to ball 135. Inthat case, the tissue contacting features on the bottom of stabilizerfeet 105 and 110 are designed to have high friction against the surfaceof the heart, for example, by using a textured surface or the like. Ifdesired, negative pressure or vacuum may be applied to stabilizer feet105 and 110 so that the beating heart may be engaged or captured by thesuction created within a vacuum chamber or a plurality of suction ports.With a localized portion of the beating heart so engaged againststabilizer feet 105 and 110, the heart portion may be renderedsubstantially motionless by fixing an attached shaft to a stationaryobject, such as a surgical retractor as described above.

Continuing to refer to FIGS. 1A-4, ball 135 is preferably connected tomanifold base 120 by way of post 130. Ball 135 and post 130 may have anysuitable construction which provides the necessary attachment of thestabilizing shaft or other stabilizing structure and which can withstandthe loads required to stabilize the beating heart with minimaldeflection. The ball and post may be integrally molded features on themanifold base itself or may be separate components mechanically securedto manifold base 120 using, for example, a threaded or snap-fitconnection or the like.

When manifold base 120 is constructed of a plastic material, it may bedesirable to fix post 130 to a relatively rigid support member to helpspread stabilization loads transmitted through post 130 over a largerarea of manifold base 120. Preferably, post 130 is rigidly attached tosupport member 155 which is made of a metal such as aluminum orstainless steel. In a preferred embodiment, support member 155 issecured within holding features such as cavities or pockets 156 and 158formed in rear manifold portion 124 and front manifold portion 122,respectively. Support member 155 may be secured within pockets 156 and158 by a simple interference fit as manifold portions 122 and 124 areurged into their final assembled positions or may be held in place usingmechanical fasteners, adhesive, or suitable bonding or weldingtechnique.

When the tissue stabilizer is configured to use vacuum stabilization orvacuum-assisted stabilization, manifold base 120 preferably has afitting or the like to which a vacuum supply may be connected. In apreferred embodiment, manifold base 120 has inlet tube 115 having aninlet opening 117. Inlet tube 115 is preferably in fluid communicationwith a hollow space or chamber 134 formed within manifold base 120.Manifold base 120 and internal chamber 134 provides for convenientdistribution of a single vacuum source connected to inlet tube 115 tomultiple stabilizer feet fluid connections, in this case to stabilizerfeet 105 and 110. Inlet tube 115 may have one or more barbs 119 tofacilitate the secure and leak-free attachment of a length of flexibletubing (not shown) coming from a vacuum pump or other vacuum source (notshown) as is commonly known in the art. In an alternative embodiment,inlet tube 115 may be replaced with a generally cylindrical bore adaptedto accept an O-ring sealed fitting forming a dynamically sealed rotatingconnection between the fitting and the manifold base similar inconstruction to the stabilizer foot connection described below withregard to FIG. 3.

For ease of manufacturing, manifold base 120 is preferably made in twoor more portions and fixed together to form a sealed, hollow interior.In a preferred embodiment, manifold base 120 has front manifold portion122 and rear manifold portion 124 which may be bonded together alongbond line 125 as shown. The internal chamber 134 may reside primarily ineither or both of front and rear manifold portions 122 and 124. Tomaximize the volume of internal chamber 134 for a given outer-profile ofmanifold base 120, a portion of internal chamber 134 is formed in rearmanifold portion 124 and one or more internal cavities 128 are includedwithin front manifold portion 122.

The manifold portions are preferably injection molded and may be fixedtogether using standard mechanical fasteners, a snap fit construction,or any suitable adhesive, bonding, sealing, or welding techniquecompatible with the material of manifold base 120. To facilitatereliable bonding between the manifold portions, the manifold portionsmay have close fitting overlapping flanges. In a preferred embodiment,best illustrated in FIG. 3, rear manifold portion 124 has an innerflange 152 and front manifold portion 122 has an overlapping outerflange 154. This construction provides a particularly reliable sealedjunction between front and rear manifold portions 122 and 124,especially when used in conjunction with a suitable gap-fillingadhesive.

As mentioned above, stabilizer feet 105 and 110 are secured to manifoldbase 120. Stabilizer feet 105 and 110 may be fixed in place in anyconvenient manner and immovable relative to manifold base 120. Morepreferably, however, stabilizer feet 105 and 110 are moveable relativeto manifold base 120. Most preferably, stabilizer feet 105 and 110 areindependently moveable with respect to each other as well. This allowsthe tissue engaging features of the tissue stabilizer to be optimallyadjusted with respect to the size and shape of the tissue to bestabilized and, once engaged and in operation, may also allow thestabilizer feet to be moved to optimize the presentation of thestabilized tissue, and more particularly the target coronary artery.

In a preferred embodiment, stabilizer feet 105 and 110 are connected tomanifold base 120 in a manner which allows each foot to rotate relativeto the manifold base 120. The axis about which the stabilizer feet 105and 110 rotate may be in any orientation that provides the desiredstabilizer feet orientation relative to the heart for optimum engagementor tissue presentation. Typically, the axis of rotation is orientedgenerally in the same direction as the direction stabilizer feet 105 and110 extend from manifold base 120, although the axis of rotation and thedirection the stabilizer feet extend may be offset from each other.Thus, the axis of rotation of the first stabilizer foot relative to thebase member may be offset from the axis of rotation of the secondstabilizer foot relative to the base member.

In a preferred embodiment, the axis of rotation is preferably at anangle of no more than about 25° with respect to the included plane orsurface approximated by the features adapted to engage the tissuesurface to be stabilized. More preferably, the axis of rotation for eachstabilizer foot 105 and 110 is generally parallel to the featuresadapted to engage the tissue surface to be stabilized. When the tissueengaging features are curved to have a radius of a constant or variedradius or an otherwise non-planar, the axis of rotation is oriented asdescribed above relative to a best-fit plane approximating the tissueengaging features or a central tangent plane. Most preferably, the axisof rotation for each stabilizer foot is also angled with respect to eachother at an angle of no more than about 30°, and more typically the axisof rotation of stabilizer foot 105 is generally parallel to the axis ofrotation of stabilizer foot 110.

Referring to FIG. 3, a preferred stabilizer foot connection isillustrated with respect stabilizer foot 110. Manifold base 120, andmore specifically front manifold portion 122, has a bore 149 extendingthrough the exterior wall. Stabilizer foot 110 has an end portion orfitting 137 having an outside diameter 148 adapted to mate with bore 149to allow fitting 137, and thus stabilizer foot 110, to rotate aboutcentral axis 133 of bore 149. In the configuration shown, central axis133 is offset from the features which engage the tissue to bestabilized, in this case perforated screen 141. This offset facilitatesimproved vessel presentation as stabilizer feet 105 and 110 are rotatedbecause, in addition to changing the overall orientation of the tissueengaging features, the eccentric relation of the tissue engagementfeatures relative to the central axis moves the stabilizer feet togetheror apart as the stabilizer feet are rotated. This action allows thetissue and included coronary artery held between the stabilizer feet tobe stretched or compressed as desired by rotating either or both ofstabilizer feet 105 and 110 after they have become operably engaged withthe tissue.

In a preferred embodiment of the present invention, the tissuestabilizer 100 is constructed to supply a negative pressure or vacuum tostabilizer feet 105 and 110 to assist in the engagement of the surfaceof the heart. Stabilizer feet 105 and 110 preferably have a hollowinterior 132 to which a vacuum may be supplied through vacuum inlet 131of fitting 137, vacuum chamber 134, and vacuum inlet tube 115, which areinterconnected in a manner which does not allow any significant vacuumleaks. Collectively, the structures comprise a vacuum conducting chamberthat communicates a negative pressure from a vacuum source to thesurface of the beating heart. Vacuum inlet tube 131 may optionally haverestriction or aperture (not shown) provided therein to restrict theamount of flow through vacuum inlet tube 131 when the sealed engagementagainst the tissue to be stabilized is broken. This allows vacuumchamber 134 of manifold base 120 to continue to provide sufficientvacuum to one stabilizer foot even when the engagement seal of the otherstabilizer foot is compromised.

To allow vacuum to be communicated to the engagement features ofstabilizer feet 105 and 110, the rotating connection between stabilizerfeet 105 and 110 and manifold base 120 must be sealed to prevent anyvacuum loss. This preferably accomplished using an appropriate dynamicannular or shaft seal that seals between the stabilizer foot andmanifold base 120 but yet allows for rotation of the stabilizer footwithin bore 149 without incurring any vacuum loss. Preferably, a sealsuch as O-ring 145 is positioned within an annual seal cavity 146 at theentrance of bore 149. The seal is captured and compressed within sealcavity 146 by cooperating annular seal flange 147 provided on stabilizerfeet 105 and 110 as the stabilizer feet are urged into final position.Stabilizer feet 105 and 110 may be held in position by operation of anspring clip or e-clip 150 assembled to fitting 137 just beyond its exitof bore 149.

Hollow interior 132 is generally a closed chamber except for one or moreopenings for engaging the heart. As will be discussed in more detailbelow, the engagement opening or openings may be in the form of aperforated screen having a relatively large number of perforations orsmall holes which engage the surface of the heart, a single openinghaving a defined perimeter for sealing against the surface of the heart,or a plurality of individual suction pods each having a sealingperimeter.

Referring to FIGS. 2 and 3, stabilizer feet 105 and 110 include thinperforated sheets or screens 140 and 141, respectively which have afront surface 144 oriented to engage the surface of the heart.Perforated screens 140 and 141 are supported around their perimeter by asupport step 138 which preferably has a raised perimeter edge or border139. Perforated screens 140 and 141 are characterized as having aplurality of perforations or holes 142. Preferably, perforated screens140 and 141 are fabricated to have a contour or shape which correspondsto the expected size and shape of the cardiac tissue to be stabilized.For example, perforated screen 140 and 141 may have a radius, R, whichmay be constant or variable.

As front surfaces 144 of perforated screens 140 and 141 are urgedagainst the surface of the heart (or other tissue structure), the heartbegins to contact front surface 144 around each perforation 142 and thussealingly covering each perforation 142. As each perforation 142 iscovered in this manner, the relatively small portion of tissue residingover each perforation 142 is subjected to the vacuum existing withinhollow interior 132 and is accordingly sucked against, and even slightlyinto, perforation 142.

Because the total vacuum or suction force applied to the tissue is afunction of the total tissue area exposed to vacuum, it is desirable forscreens 141 and 142 to have the aggregate area of all the perforationsas great as possible and still maintain the required structuralintegrity. In a preferred embodiment, the unperforated material betweenadjacent perforations is between about 0.015 inches (0.38 mm) and about0.025 inches (0.635 mm) at its smallest point, most preferably about0.02 inches (0.51 mm), and the diameter of the perforations are fromabout 0.06 inches (1.524 mm) to about 0.09 inches (2.286 mm).

A particularly advantageous configuration of front surface 144 includesa plurality of projections or protrusions disposed at a number oflocations between the holes or perforations. FIGS. 8A and 8B illustratea perforated member 400 having a front contact surface 410 which has anumber of perforations or holes 415. The unperforated material of member400 has a plurality of projections 420 extending outwardly from contactsurface 410. In a preferred embodiment, a plurality of projections aregenerally equally spaced around each perforation 415. The projectionsmay be formed, for example, by chemical machining or etching.Projections 420 operate to more aggressively bite or engage tissuestructure 425 as it is urged into perforation 415 by operation of anapplied vacuum.

In the embodiments shown in FIGS. 2 and 3, the outermost extendingsurface of border 139 is generally even or flush with front surface 144of perforated screens 140 and 141. To maximize the total area of tissueexposed to vacuum, it may be desirable to have a raised border orperimeter which exposes and subjects all the tissue within its boundaryto the negative pressure supplied through the interior of the stabilizerfeet. FIG. 5 illustrates tissue stabilizer 200 having a perimetersealing member 215 disposed at the bottom of each stabilizer foot 205and 210. Perforated screens 140 and 141 are recessed from perimetersealing member 215.

When perimeter sealing member 215 makes contact with the surface of theheart around substantially its entire perimeter, the portion of theheart tissue within the perimeter is subjected to the negative pressureexisting within the hollow interior of stabilizer feet 205 and 210 andis urged into engagement with stabilizer feet 205 and 210. The negativeor vacuum pressure may be sufficient to displace the portion hearttissue within the vacuum chamber created by perimeter sealing member 215into forced contact with perforated screens 140 and 141. To furtherincrease traction, perforated screens may optionally have projections asdescribed above.

An exploded view of tissue stabilizer 200 is shown in FIG. 6. Frontmanifold portion 122 has first and second bores 222 and 223 forreceiving tubular members or fittings 208 associated with stabilizerfeet 205 and 210, respectively Fittings 208 are preferably integrallymolded features of stabilizer feet 205 and 210, but could alternativelybe separate fittings secured to the stabilizer feet by way of, forexample, a bonded, welded, or threaded connection. Fittings 208 have aflange 212 for retaining and compressing O-ring 202 within the sealcavity (not visible in this view) and groove 214 for receiving aexternal retaining ring, preferably of the spring type, e-type or thelike. Fittings 208 preferably have a vacuum inlet opening 220 forcommunicating the negative pressure within manifold base 120 to thehollow interior region within stabilizer feet 205 and 210.

The multifunctional components of tissue stabilizer 200 allow for simpleand convenient assembly. Stabilizer foot 205 may be assembled to frontmanifold portion 222 by installing O-ring 202 over fitting 208 and theninstalling fitting 208 through bore 222. Fitting 208 and stabilizer foot205 is secured in place by securing an external retaining ring 218, intoplace within groove 214. The same procedure is then used to installstabilizer foot 210 to manifold portion 222. Post support member 155 isplaced in the proper location between or within front and rear manifoldportion 122 or 124 as the two manifold portions are brought together inthe presence of an appropriate bonding agent or adhesive to make theassembly leak-free, air-tight, and permanent. Perforated screens 140 and141 may be secured to stabilizer feet 205 and 210 at any convenient timebefore or after the assembly procedure just described.

Tissue stabilizer 300, shown in exploded view in FIG. 7, allowsstabilizer feet 305 and 310 to be assembled to front manifold portion122 using a simple snap-fit construction instead of an externalretaining ring. In this variation, the fitting portions of stabilizerfeet 305 and 310 include a seal flange 310, an uninterrupted baseportion 304 and a number of flexures 302 having raised end features 303.Flexures 302 allow raised features 303 to flex inwardly so that they fitthrough bore 222 and 223 and then flex outwardly as they exit bores 222and 223, thus becoming locked in place.

Tissue stabilizer 300 may be assembled using the same basic procedure asdescribed above with reference to tissue stabilizer 200. In addition,however, because there is no retaining feature to be installed to thefitting portion after placement through bores 222 and/or 223, the frontand rear manifold portions 122 and 124 can be fully assembled and leaktested (if desired) before stabilizer feet 305 and 310 are installed.Thus, post support member 155 is positioned in place in or between frontand rear manifold portions 122 and 124 as the two manifold portions arebrought together in the presence of an appropriate bonding agent oradhesive to secure the manifold base assembly together. An O-ring 202 isthen placed over uninterrupted portion 304 adjacent flange 310 andraised features 303 on flexures 302 are urged through bore 222 or 223until it exits the bore and snaps open and into place, thus fixingstabilizer foot 305 or 310 to the assembled manifold base.

Tissue stabilizer 300 shows a variation in which a stabilizer shaft 307is pre-installed on ball 135. Stabilizer shaft 307 has a socket housing306 which is permanently operably attached to ball 135. The ball 135 andpost 130 is dropped into housing 306 from a distal direction prior tofixing shaft 307 thereto. Post support member 155 is then fixed to theproximal end of post 130, rendering the assembly essentiallyinseparable. This eliminates any possibility of accidental separation ofthe stabilizer foot from the stabilizer shaft.

To gain the advantage of stabilizer feet having different constructionsfor different procedures or patients, the foregoing design allows thedesired stabilizer feet to simply be snapped into place within bores 222and 223, for example, after a clinical determination has been maderegarding what size, type, etc. of stabilizer feet will be presentlyrequired. Once snapped into place, stabilizer feet 305 and 310 may berotated to obtain the desired orientation of each foot to providemaximum stabilization based on the clinical situation presented by anindividual patient.

Stabilizer feet 305 and 310, or any of the other stabilizer feetdescribed herein, may be provided with additional features to facilitateadjustment of stabilizer feet 305 and 310 after engagement with thetissue to be stabilized. The features may be any holes, lever,protrusion, projection, or other suitable feature that allows thestabilizer feet to be easily manipulated during use. Since it isdesirable for the device to have an unobstructingly low-profile,especially in the area of the stabilizer feet, the adjustment featuresare preferably one or more blind holes 308 adapted to receive a bluntinstrument for manipulating the orientation of stabilizer feet 305 and310. Alternatively, a hex or nut-shaped feature could be added to eachstabilizer foot distal of the seal flange for use with an appropriatelysized wrench or the like to rotate the stabilizer feet.

Perimeter sealing member 215 may have a variety of constructions.Sealing member 215 may simply be an integral extension of the stabilizerfoot material. In that instance, sealing member 215 will typically be arelatively hard polymer or plastic material. Sealing member 215 may alsobe a relatively soft elastomer which is attached to or over-molded onstabilizer feet 205 and 210. Sealing member 215 may also be constructedof a compressible foam material, preferably a closed cell foam. Theelastomer or foam materials will preferably compress, deflect orotherwise yield somewhat as the stabilizer feet become engaged with theirregular surface of the heart When sealing member 215 is constructed ofan elastomer or foam material, it will preferably have a durometerhardness in the range from about 35 Shore-A to about 100 Shore-Adepending on the geometrical configuration of sealing member 215.

In a preferred embodiment, the perimeter seal has a variable thicknessaround its perimeter to provide a more reliable seal against thecurvature of the surface of the heart, especially when the heartcontinues to beat during the procedure. FIGS. 9A and 9B show a portionof a stabilizer foot 430 having a perimeter seal 440 with a variableheight or thickness around its perimeter. Similar to the previouslydiscussed configurations, stabilizer foot 430 has a hollow interior 449to which a negative pressure is communicated. Perforated screen 435 hasa plurality of holes or perforations 437 and is mounted in position onstep feature 447 within stabilizer foot 430. Perimeter seal 440 ismounted at or near the bottom of stabilizer foot 430, and is preferablyretained within a groove or step 448.

The height that perimeter seal 440 extends from the bottom of stabilizerfoot 430, typically varies at different locations around the perimeterof perimeter seal 440. For example, the tip height 441 and rear height443 is generally greater than midpoint height 442 along either side ofthe stabilizer foot. In addition, height 446 of perimeter seal 440 alongthe inside of stabilizer foot 430, that is the side closest to thetarget artery, is generally less that the outside height 444 at acorresponding location along the stabilizer foot 430.

The variable height results in a contoured shape of perimeter seal 440which tends to remain sealed against the heart when the heart expandsand contracts as it beats to pump blood. In a preferred embodimentperimeter seal 440 is made from an elastomer, a closed-cell foam, orother flexible or compressible material to further optimize the abilityof stabilizer foot to maintain its seal on the tissue to be stabilized.If the seal is broken or otherwise compromised, the stabilizer foot maydisengage from the surface of the heart, adversely affectingstabilization. Seal 440 may be fixed to the stabilizer foot using anadhesive or bonding agent or may be made integral with the stabilizerfoot using an injection over-molding process wherein seal 440 is moldedover the stabilizer foot.

Another seal variation is illustrated with reference to stabilizer foot450, a portion of which is shown in FIG. 10. Stabilizer foot 450 againhas a hollow interior 449 and a perforated screen 435 havingperforations or holes 437. In this variation, stabilizer foot 450 has aflexible seal 455 having first and second legs 458 and 459 disposed inan angular relationship which operates as a highly flexible jointallowing perimeter edge 456 to move relatively freely towards and awayfrom the bottom of stabilizer foot 450 as required to effectuate areliable seal against the surface of the tissue to be stabilized. Forexample, if the tissue under vacuum engagement with stabilizer foot 450contracts and moves away from the tip of stabilizer foot 450, flexibleseal 455 can easily follow the movement to a new extended position 4551without the seal being broken.

Flexible seal 455 is preferably made from a medical grade elastomericmaterial such as silicone, urethane rubber, neoprene, nitrile rubber,hytrel, kraton, or other suitable material. Flexible seal 455 may beseparately formed and later attached to stabilizer foot 450 or may beintegrally over-molded onto stabilizer foot 450. For secure attachmentto stabilizer foot 450, flexible seal 455 may optionally be providedwith seal base portion 457.

If greater extension of the flexible seal's perimeter sealing edge awayfrom the stabilizer foot is required, a seal having a greater number offlexible legs in a bellows or accordion type arrangement is employed.Referring to FIG. 11, stabilizer foot 460 has flexible seal 465 havingcontinuously connected alternating flexible legs in the form of abellows. Flexible seal 465 may include a base 467 to facilitateattachment to the bottom of stabilizer foot 460 and has a perimeter edge466 to effectuate a reliable seal against the surface of the tissue tobe stabilized. This type of seal generally compresses to a relativelysolid, stable structure as the stabilizer foot is urged against thesurface of the tissue, has a the ability to follow moving tissue over arelatively long travel if required, and yet occupies only a very smallamount of space around the perimeter of the stabilizer foot.

Another flexible seal arrangement is illustrated in FIGS. 12-13B withreference to tissue stabilizer 470. Tissue stabilizer 470 has a manifoldbase 473 comprised of front manifold portion 472, rear manifold portion474 having vacuum inlet tube 471, and ball 476 to which a stabilizingshaft may be attached. Stabilizer feet 475 and 480 may be attached tostabilizer base 473 in any of the ways discussed above. Most preferably,stabilizer feet 475 and 480 have a fitting portion 485 which includes anuninterrupted cylindrical portion 486, one or more flexures 487 eachhaving raised features 488 that provide a positive snap-fit joint incooperation within cylindrical bores formed in front manifold portion472 as described in detail above. Preferably, fitting 485 has a flange479 for retaining and compressing a shaft seal or the like.

Stabilizer feet 475 and 480 have attached thereto flexible seals 482 and477, respectively. Flexible seals 477 and 482 may extend completelyaround the perimeter of stabilizer feet 480 and 475. More preferably,stabilizer feet 475 and 480 have at least one portion of its perimeterhaving a flexible seal and at least one portion without a flexible seal.According to this variation of the present invention, the stabilizerfeet 475 and 480 are primarily sealed against the target tissue byoperation of their own perimeter edge 481. Flexible seals 482 and 477are provided generally outside of perimeter edge 481 to provide a formof secondary or back-up seal in the event the seal at perimeter edge 481becomes compromised as a result of misalignment or movement of thetissue. Flexible seals 477 and 482 are preferably sufficiently flexibleto remain in contact with the movements of the beating heart so thatwhen the seal breaks along 481 perimeter edge the vacuum loss iscontained within flexible seal 482 or 477. This containment typicallyallows the comprised area of perimeter edge 481 to become re-engagedagainst the tissue without significant vacuum loss.

After engagement and stabilization of the beating heart, the vacuum sealformed at the perimeter edge of the stabilizer feet may be most likelyto break at the tip region or along the outside edge of the stabilizerfoot as the heart contracts away from the site of stabilization. In suchcircumstances, flexible seals 477 and 482 need only be associated withthese problem areas, leaving inside perimeter portion 478 and the spacebetween stabilizer feet 475 and 480 open to avoid obstructing thesurgical field of the anastomosis. Flexible seals 477 and 482 have acontoured outer periphery 483 which may be a relatively large distanceaway from the outer extents of the stabilizer feet 475 and 480 and mayinclude extended tip portions 484. Flexible seals 477 and 482 preferablyhave a top portion for attaching to the stabilizer feet about theperimeter edge 481. Flexible seals 477 and 482 may be fixed in placeusing an adhesive or bonding agent or may be integrally over-molded aspart of stabilizer feet 475 and 480.

Another way to prevent a complete loss of engagement and stabilizationof the target tissue due to a compromised perimeter seal resulting frommisalignment of the stabilizer feet or movement of the target tissue tobe stabilized, is to partition the vacuum chamber within the stabilizerfeet into a plurality of chambers connected to the vacuum source throughonly a small aperture. In that way, a vacuum leak at a single locationwill is result in a reduced ability to maintain engagement of thatpartitioned section only and will not immediately compromise theengagement of the entire stabilizer foot. Of course, it may be desirableto combine any one of the flexible seals described above withpartitioning to further increase the reliability of the stabilizer footseal against the tissue structure to be stabilized.

A tissue stabilizer embodiment having stabilizer feet with a partitionedvacuum chamber is illustrated in FIGS. 14 and 15. Tissue stabilizer 500has a manifold base 501, preferably having front and rear manifoldportions 504 and 502, to which first and second stabilizer feet 505 and506 are attached. First and second stabilizer feet 505 and 506 haveperimeter seal edges 507 and 508 which generally define the extents ofthe vacuum chambers for each stabilizer foot. One or more partitions509, each having a sealing edge 511, are provided to divide stabilizerfeet 505 and 506 into two or more vacuum subchambers. By way of exampleonly, stabilizer feet 505 and 506 have partitions 509 which divide thevacuum space into first, second, third, and fourth vacuum subchambers517, 518, 549, and 520, respectively.

Vacuum feed tube 510 is provided along the interior of stabilizer feet505 and 506 to communicate the negative pressure from within themanifold base to each of subchambers 517, 518, 519, and 520. Vacuum feedtube 510 preferably has a side opening or aperture 512 within each ofsubchambers 517, 518, and 519. Vacuum feed tube 510 may have an endopening or aperture 513 within subchamber 520. The apertures 512 and 513facilitate the separate communication of negative pressure to eachvacuum subchamber and are preferably sized such that when one subchamberencounters a vacuum leak, the aperture is restricted enough so that thevacuum in the other subchambers can be maintained by the vacuum source.

Stabilizer feet 505 and 506 are preferably rotatable with respect tomanifold base 501 as discussed at length above. For example, stabilizerfeet 505 and 506 may have a fitting portion 515 which is preferablycylindrical to cooperate with a mating bore provided in manifold base501. Fitting portion 515 may have a flange 514 for retaining a shaftseal and a groove for receiving an external retaining ring to securefitting portion 515 within manifold base 501. The bottom of stabilizerfeet 505 and 506 may have a contoured shape having a variable or fixedradius, R. A flexible seal may optionally be included along one or allof sealing edges 507, 508, and 511.

A partitioned vacuum chamber as described above maximizes the areaexposed to negative pressure for a particular size of stabilizer foot.That is, the ratio of the surface area exposed to negative pressuredivided by the total surface area included with the boundary at thebottom of the stabilizer foot is maximized by the partitioned chamberconfiguration just described. In another embodiment, although lessefficient in that regard, rotatable stabilizer feet can be constructedto have a number of individual vacuum ports or pods.

FIGS. 16 and 17 illustrate stabilizer foot 550 having a plurality ofindividual vacuum ports. By way of example only, stabilizer foot 550 hasfour suction ports 551, 552, 553, and 554 each with a dedicated edgeseal 561. Negative pressure is communicated to each port throughopenings or apertures 560 provided in vacuum distribution passage 563which is fluid communication with vacuum inlet 562 which in turn isplaced in fluid communication with the negative pressure within amanifold base assembly having a construction as described above.Stabilizer foot 550 may be mounted for rotation within a cooperatingbore of an appropriate manifold base by way of cylindrical fittingportion 556 which may include a seal flange 555 and groove 557 forreceiving an external retaining ring to secure fitting portion 556 inplace.

FIGS. 18 and 19 show a variation of a stabilizer foot having a pluralityof individual ports. Stabilizer foot 575 again has a fitting portion 599having a seal flange 598 for retaining and compressing an appropriateshaft seal to provide the desired dynamic seal as stabilizer foot 575 isrotated about fitting portion 599. To facilitate even greater adjustmentof the shape and orientation of stabilizer foot 575 has a first footportion 580 with at least one vacuum port and a second foot portion 585with at least one vacuum port which are adjustable relative to oneanother, preferably by way of one or more malleable joints or links.

In a preferred embodiment, first foot portion 580 has a plurality ofseparate vacuum ports 581 each with a perimeter seal 582. Preferably,first foot portion 580 has three vacuum ports 581 each supplied withnegative pressure through apertures 578 in vacuum distribution channelor passage 593. Second foot portion 585 has at least one vacuum port 583having perimeter seal 584 and aperture 577 in fluid communication withvacuum passage 592. First foot portion 580 and second foot portion 585are preferably connected to each other by malleable tube 590, which hasa lumen or passage 591 therethrough. Malleable tube 590 is preferablymade of stainless steel, more preferably annealed stainless steel orvacuum annealed stainless steel.

With this configuration, the vacuum communicated from a manifold base orother vacuum source through vacuum inlet channel 595 is distributed tovacuum ports 581 and 583 through vacuum distribution channel 593 andassociated apertures 578, through malleable tube passage 591, finally tovacuum passage 592 and associated aperture 577. The orientation ofsecond foot portion 585 and thus vacuum port 583 can be adjustedrelative to first foot portion 580 by simple bending it to the desiredorientation. This additional adjustment tends to eliminate problemsassociated with obtaining a reliable seal at the tip of the stabilizerfoot as the beating heart contracts away from the stabilizer, yetmaintains the reliability of having ports 603 molded to a unitaryrelatively rigid stabilizing structure.

Malleable tube 590 may be secure to first foot portion 580 and secondfoot portion 585 in any convenient manner which provides a permanent andsealed connection. Preferably, the exterior of malleable tube 590 may bepressed into mating counterbores 596 and 597 provided in the ends ofVacuum passages 593 and 592 as shown. A suitable adhesive or bondingagent may additionally be used to sealingly secure malleable tube 590 inplace. Alternatively, malleable tube 590 and counterbores 596 and 597may be threaded together or malleable tube 590 could be insert moldedwithin first and second foot portions 580 and 585.

FIGS. 20 and 21 illustrate another embodiment of a stabilizer foothaving foot portions which are adjustable relative to one another toimprove the fit, and accordingly the operating vacuum seal, against thesurface of the tissue structure to be stabilized. Stabilizer foot 600has a first foot portion 601 and a second foot portion 602. First footportion 601 has one or more, preferably three, vacuum ports 603 andsecond foot portion 602 has one or more vacuum ports 608. Each of vacuumports 603 and 608 preferably have a flexible or compressible perimeterseal 604 and 609, respectively, preferably made of a medical gradeelastomer or foam. Negative pressure is supplied to vacuum ports 603 and608 through openings or apertures 715 and 716 which in fluidcommunication with vacuum passages 711 and 712. Negative pressure issupplied to vacuum passage 711 through inlet channel or passage 710 offitting portion 718. Fitting portion 718 connected to a vacuum chamberor source within a manifold base or like structure as described above.

First foot portion 601 and second foot portion 602 are made adjustablerelative to each other by providing one or more malleable links spanningbetween the two portions. In one variation, first and second malleablemembers 606 and 607 are located off-center with respect vacuum ports 603and 608. The off-center position of malleable members 606 and 607 betterprotects against excessive torsional loads applied to tube 605 if secondfoot portion 602 were twisted relative to first foot portion 601.

Malleable members 606 and 607 may be glued or bonded within cavities orbores provided within first and second foot portions 601 and 602 or maybe insert molded during fabrication of the foot portions. Tube 605fluidly connects vacuum passages 711 and 712. In this case, tube 605 maybe malleable or may be a flexible tubing material. Preferably, tube 605is assembled within counterbores 713 and 714.

In operation, the tissue stabilizers of the present invention allow thestabilizer feet, and in particular the features which operate to engagethe surface of the tissue to be stabilized, to be optimally adjusted tofor a specific surgical procedure or to adjust for variations in sizeand orientation of a patient's anatomy. In addition, the stabilizer feetcan be adjusted after engagement to the tissue to be stabilized toproduce an improved presentation of the tissue subject to the surgicalprocedure.

In a preferred method of operation for a tissue stabilizer having firstand second rotatable stabilizer feet connected to a manifold base havinga stabilizer shaft attached thereto, one or both of the stabilizer feetare adjusted to the desired orientation relative to the manifold baseand each other. Preferably, the orientation of the stabilizer feet areadjusted to account for the size and shape of the tissue to bestabilized, for example a target site on the surface of the heart. Ifeither of the stabilizer feet have an adjustable portion, it may also beadjusted at this time. Next, the tissue stabilizer is brought intoengagement with the tissue to be stabilized and the vacuum is applied.The stabilizer shaft is then locked into place to immobilize the tissuestabilizer and the engaged tissue. With the surgical site now relativelymotionless, one or both of the stabilizer feet may be rotated relativeto the manifold base until the tissue between or adjacent the stabilizerfeet obtains the best possible presentation for the procedure to beperformed. If there appears to be any discernible vacuum leaksassociated with the engagement of the stabilizer feet against the targettissue, the orientation of the stabilizer feet may be further adjustedor, if applicable, the feet portions may be adjusted, to eliminate orminimize vacuum leaks at the interface between the stabilizer feet andthe target tissue.

Although the illustrative stabilizer feet described above have beenprimarily directed to embodiments configured for connection to a commonmanifold base, the stabilizer feet of the present invention will operatewith equal benefit when connected to any number of alternativestructures. For example, FIG. 22 illustrates tissue stabilizer 725having a stabilizer foot rotatably connected with respect to a portionof common tubing having a flared end. Tube 740 may be a malleable tube,for example made of annealed stainless steel, which may be connectedproximally to a manifold (not shown) shared with a second stabilizerfoot or may be connected directly to a fixed mount (not shown) toeffectuate stabilization.

In a preferred embodiment, stabilizer foot 730 is connected to housing735 which rotates about tube 740. Tube 740 has a flared end 742 as iscommonly known in the art. A shaft seal, such as O-ring 732, is placeover tube 740 adjacent flared end 742. Housing 735 has a first bore 737and a second larger bore 738. First bore 737 is larger than the outsidediameter of tube 740 but preferably smaller than the diameter of flangedend 742. Second bore 738 is preferably slightly larger than flanged end742. Tube 740 with O-ring 732 is assembled through second bore 738 untilthe O-ring is compressed at the distal entrance to first bore 737. AnO-ring cavity 736 may be provided if desired. Fitting portion 734 isinserted into second bore 738 and permanently fixed in place preferablyusing a fluid tight connection such as pipe threads, adhesive, bondingagent, welding, brazing, etc. With fitting portion 734 fixed to housing735, stabilizer foot 730 and housing 735 may be rotated relative to tube740 without any appreciable vacuum leakage. Stabilizer foot 730 may beof any desirable configuration.

While certain embodiments are illustrated in the drawings and have justbeen described herein, it will be apparent to those skilled in the artthat many modifications can be made to the embodiments without departingfrom the inventive concepts described. For purposes of illustrationonly, the principles of the present invention has been described withreference to stabilizing the heart during a coronary artery bypassprocedure but may readily be applied to other types surgical procedureson various types of tissue structures not specifically described. Manyother uses are well-known in the art, and the concepts described hereinare equally applicable to those other uses. Further, the differentcomponents and their equivalents of the various exemplar embodimentsdescribed above can be combined to achieve any desirable construction.

1-42. (canceled)
 43. A device for stabilizing tissue within a patient'sbody, said device comprising: a base member defining a base vacuumchamber and having a distal surface; and at least one elongatedstabilizer foot extending outwardly from said distal surface of saidbase member in a first direction and fluidically connected with saidbase vacuum chamber, said at least one stabilizer foot being rotatable,in its entirety, relative to said base member about an axis of rotation.44. The device according to claim 43, wherein said stabilizer foot isconnected to said base member through a dynamically sealed rotatingconnection.
 45. The device according to claim 44, wherein connectionallows for rotation of said stabilizer foot without incurring any vacuumloss.
 46. The device according to claim 45, wherein said stabilizer footmay be rotated without incurring any vacuum loss when said stabilizerfoot is operably engaged to tissue.
 47. The device according to claim44, wherein said connection is a dynamic annular or shaft seal thatallows for rotation of said stabilizer foot without incurring any vacuumloss.
 48. The device according to claim 43, wherein said axis ofrotation is oriented in substantially the same direction as said firstdirection.
 49. The device according to claim 43, wherein said axis ofrotation is oriented at an angle of no more than about 25 degrees tosaid first direction.
 50. The device according to claim 43, wherein saidstabilizer foot comprises features adapted to engage a surface of thetissue, said features approximating the surface, and wherein said axisof rotation is angled with respect to said surface.
 51. The deviceaccording to claim 43, wherein said elongated stabilizer foot comprisesa hollow chamber extending substantially over the length of saidelongated stabilizer foot.
 52. The device according to claim 43, whereinsaid device comprises two elongated stabilizer feet.
 53. The deviceaccording to claim 43, wherein said at least one elongated stabilizerfoot comprises a tissue engaging feature with a non-planar perimeter.54. The device according to claim 53, wherein said tissue engagingfeature has a constant radius of curvature.
 55. The device according toclaim 53, wherein said tissue engaging feature has variable radius ofcurvature.
 56. A device for stabilizing tissue within a patient's body,said device comprising: a base member defining a base vacuum chamber andhaving a distal surface; and at least one elongated stabilizer footcomprising a plurality of individual vacuum ports said stabilizer footextending outwardly from said distal surface of said base member in afirst direction and fluidically connected with said base vacuum chamber,said at least one stabilizer foot being rotatable, in its entirety,relative to said base member about an axis of rotation which is orientedin substantially the same direction as said first direction. (page 30lines 8-10).
 57. The device of claim 56, wherein said individual vacuumports independently engage said tissue.
 58. The device of claim 57,wherein each of said individual vacuum ports has a compressibleperimeter seal.
 59. The device of claim 56, wherein said elongatedstabilizer foot comprises a first foot portion comprising at least onevacuum port and a second foot portion comprising at least one vacuumport, wherein said first and said second foot portions are adjustablerelative to one another.
 60. The device of claim 59, wherein said firstand said second foot portions are adjustable relative to one another byway of one or more malleable joints.
 61. The device of claim 59, whereinsaid first and said second foot portions are rigid.
 62. The device ofclaim 56, wherein said elongated stabilizer foot is rotatably mounted onsaid base member and rotation of said stabilizer foot does not incur anyvacuum loss.
 63. A device for stabilizing tissue within a patient'sbody, said device comprising: a base member; and an elongated stabilizerfoot extending outwardly from said base member in a first direction andfluidically connected with said base member, said foot having non-planartissue-engaging features, said foot being rotatable, in its entirety,relative to said base member, about an axis of rotation.
 64. The deviceof claim 63, wherein said axis of rotation is oriented relative to abest-fit plane approximating the tissue engaging features.
 65. Thedevice of claim 63, wherein said axis of rotation is oriented relativeto a central tangent plane of the tissue engaging features.
 66. Thedevice of claim 63, wherein said base is a common tube.
 67. The deviceof claim 66, wherein said device further comprises a housing connectedto said foot which rotates around said base.
 68. The device of claim 63,wherein said tube is flanged, and said tube is connected to said basemember using a shaft seal.
 69. The device of claim 68, wherein saidshaft seal is an O-ring.
 70. The device of claim 63, wherein saidelongated stabilizer foot has an elongated perimeter adapted to contactthe tissue.
 71. A device for stabilizing tissue within a patient's body,said device comprising: a base member; and an elongated stabilizer footextending outwardly from said base member in a first direction andfluidically connected with said base member, said foot having non-planartissue-engaging features comprising a perimeter seal having a variableheight around its perimeter, said foot being rotatable, in its entirety,relative to said base member, about an axis of rotation.
 72. The deviceof claim 71, wherein said stabilizer foot further comprises a perforatedscreen recessed from the perimeter seal.
 73. The device of claim 71,wherein said perimeter seal is retained within a groove in thestabilizer foot.
 74. The device of claim 71, wherein said perimeter sealis higher at a front tip of said stabilizer foot as compared to amidpoint of said stabilizer foot.
 75. The device of claim 71, whereinsaid perimeter seal is higher at a rear end of said stabilizer foot ascompared to a midpoint of said stabilizer foot.
 76. The device of claim71, wherein said height varies to form a contoured shape adapted toremain sealed against a tissue surface.
 77. A device for stabilizingtissue within a patient's body, said device comprising: a base member;and an elongated stabilizer foot extending outwardly from said basemember in a first direction and fluidically connected with said basemember, said foot having a non-planar tissue-engaging feature comprisinga perimeter seal having a variable height around its perimeter, saidfoot being rotatable, in its entirety, relative to said base member,about an axis of rotation; wherein said perimeter seal is a flexibleseal having first and second legs disposed in an angular relationship.78. The device of claim 77, wherein said perimeter seal comprises aplurality of legs angularly disposed in a bellows arrangement.
 79. Thedevice of claim 77, wherein said perimeter seal is made from anelastomeric material selected from the group consisting of: silicone,urethane rubber, neoprene, nitrile rubber, hytrel, and kraton.